Provider Demographics
NPI:1013930668
Name:SMALL, KAREN M
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 S MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6925
Mailing Address - Country:US
Mailing Address - Phone:407-808-2142
Mailing Address - Fax:407-977-5089
Practice Address - Street 1:2926 S MORNINGSIDE CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6925
Practice Address - Country:US
Practice Address - Phone:407-808-2142
Practice Address - Fax:407-977-5089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887637100Medicaid